Differential Diagnosis for Bright Red Blood Per Rectum
Single Most Likely Diagnosis
- Radiation Proctitis: This is the most likely diagnosis given the patient's history of radical hysterectomy and adjuvant radiation therapy for cervical cancer over 12 months ago. The symptoms of bright red blood per rectum, mild abdominal cramps, and the colonoscopy findings of mucosal pallor, friability, and multiple telangiectasias confined within the rectum are consistent with radiation proctitis.
Other Likely Diagnoses
- Angiodysplasia: Although less likely, angiodysplasia could be considered due to the presence of telangiectasias seen on colonoscopy. However, angiodysplasia typically presents with more chronic and less severe bleeding.
- Diverticular Colitis: The presence of scattered diverticula in the descending and transverse colon could suggest diverticular disease, but the symptoms and colonoscopy findings are more indicative of a rectal pathology.
- Ischemic Colitis: Ischemic colitis is a possibility but would typically present with more severe abdominal pain and potentially a history of vascular disease or embolic events.
Do Not Miss Diagnoses
- Clostridioides difficile Infection: Although the patient does not have fever or vomiting, it is crucial to rule out C. difficile infection, especially in a patient with a history of recent hospitalization or antibiotic use, due to its potential severity and the need for prompt treatment.
- Crohn Disease: While Crohn disease is less likely given the patient's age and lack of other symptoms, it is essential to consider inflammatory bowel disease in the differential diagnosis due to its potential for severe complications if left untreated.
Rare Diagnoses
- Vascular Malformations or Other Rare Causes of Rectal Bleeding: These would be less common causes of the patient's symptoms but should be considered if other diagnoses are ruled out and the bleeding persists or worsens.